Page 77 - Trident 2022 Flipbook

ELIGIBLE GENERAL PURPOSE FSA EXPENSE LIST:

Items Typically Eligible Items Typically Ineligible

Acupuncture Cosmetic Procedures/Drugs of any nature
Alcoholism Treatment Programs Food Costs
Ambulance Services Hair Removal
Artificial Limbs Health Club Memberships
Birth Control Insurance Premiums
Braille Books and Magazines Marriage Counseling
Breast Pumps Medical Marijuana Use
Chiropractor Services
Christian Science Practitioners Items That Typically Require a Medical
Contact Lenses Determination Letter to be Completed by a
Contact Lens Solution Licensed Practitioner:
Crutches/Canes
Dental Services Alternative Medicines and Procedures
Diagnostic Services Breast Reconstruction after mastectomy
Drug Treatment Programs Car Modifications
Eyeglasses/Exams Dietary Supplements
Guide Dog Dyslexia Treatments
Hearing Aids (and batteries) Exercise Equipment or Programs
Hospital Services Fitness Programs
Immunizations Home Improvements
Insulin Lodging (as related to medical services provided)
Laboratory Services Massage Therapy
Medical Services Orthopedic Shoes and Inserts
Nursing Services Reconstructive Surgery (following accident /injury)
Osteopathic Physician Services Special Schools (as applies to mental and physical disabilities)
Over-the-Counter Items* Swimming Lessons (as applies to treatment of medical
Over-the-Counter Medications** condition)
Oxygen Special Class Tuition (as applied to specific medical condition)
Prescription Drugs Vitamins
Psychiatric Services Weight Loss Programs (food excluded)
Transplants
Transportation for Eligible Services Rendered
Wheelchairs
X-Rays

*A list of eligible over-the-counter items is available
**A list of eligible over-the-counter items that requires a prescription to accompany the request for
reimbursement is available

Please note that an expense is only considered eligible for FSA reimbursement if it is deemed medically

necessary to treat a specific medical condition, disease or diagnosis. A Letter of Medical Determination may be

requested at any time for additional clarification. This list is meant to be used as general guidance for eligible

FSA expenses and not meant to be all-encompassing.